Tuesday, February 23, 2016

Sexually Transmitted Infections and Use of Contraceptives in Women Living with HIV in Denmark - The SHADE Cohort

BACKGROUND:

No
Danish guidelines for screening of sexually transmitted infections (STIs) in
women living with HIV (WLWH) exist, except for annual syphilis testing.
Drug-drug interaction between hormonal contraceptives and some types of highly
active antiretroviral therapy (HAART) occurs. We assessed prevalence of STIs,
contraceptive choices and predictors of condom use in a cohort of WLWH in
Denmark.

METHODS:

WLWH
consecutively enrolled during their outpatient visits from 2011 to 2012.
Gynaecological examination and an interview were performed at entry and 6-month
follow-up. Inclusion criteria were HIV-1 infection and ≥ 18 years of age.
Exclusion criteria were pregnancy, alcohol- or drug abuse impeding adherence to
the protocol. At entry, participants were tested (and where appropriate,
treated according to guidelines) for Chlamydia trachomatis, Neisseria
gonorrhoeae, syphilis, and herpes simplex (HSV-1 and HSV-2). At follow-up,
predictors of condom use were estimated in sexually active WLWH.

RESULTS:

In total,
334 of the 1,392 eligible WLWH in Denmark were included (median age and HIV
duration: 42.5 and 11.3 years). Chlamydia trachomatis was present in four
individuals (1 %), and six (2 %) tested positive for HSV-2 by PCR.
None were positive for Neisseria gonorrhoeae, HSV-1 or had active syphilis. At
follow-up, 252 (76 %) participated; 168 (70 %) were sexually active.
Contraceptives were used by 124 (75 %); condoms were preferred (62 %).
Having an HIV-negative partner predicted condom use (adjusted OR 3.89 (95 %CI
1.49-10.11)). In the group of participants of reproductive age without
pregnancy desires 13 % used no birth-control. Possible drug-drug
interaction between hormonal contraceptives and HAART was found in 13/14 WLWH
receiving both kinds of medication.

CONCLUSION:

The
prevalence of STIs in WLWH in Denmark was low. The need for annual STI
screening is questionable. Condoms were preferred contraceptives, especially in
WLWH with an HIV-negative partner. In this cohort, 13 % of WLWH of
reproductive age were at risk of unintended pregnancies due to lack of
birth-control. Finally, in the subgroup of WLWH receiving both hormonal
contraceptives and HAART possible drug-drug interactions could occur.